早卵泡期长效长方案中添加重组人黄体生成素对于IVF/ICSI助孕结局的影响

Effect of addition of recombinant human luteinizing hormone in early follicular stage long acting regimen on IVF/ICSI assisted pregnancy outcome

目的在早卵泡期长效长方案促排卵过程中外源性重组黄体生成素(LH)的添加尚未达成统一共识。文中探讨早卵泡期长效长方案中添加LH对IVF/ICSI助孕结局的影响。方法对2018年7月至2021年12月在东部战区总医院生殖医学科行早卵泡期长效长方案促排的患者进行倾向性评分匹配,共计508例患者纳入回顾性分析。根据促性腺激素(Gn)用药方案将患者分为r-FSH+HMG组[患者在促排卵方案中添加重组人卵泡激素(r-FSH)及人绝经促性腺激素(HMG)]和r-FSH+HMG+r-LH组[患者在促排卵过程中使用了r-FSH、HMG以及重组黄体生成素(r-LH)]。比较2组患者临床特征以及助孕结局差异。结果两组患者年龄、BMI、不孕年限、基础性激素水平(FSH、LH、PRL、E2、T、P)、抗苗勒氏管激素(AMH)、窦卵泡数(AFC)差异均无统计学意义(P>0.05)。两组患者Gn总量、Gn使用天数、r-FSH和HMG使用剂量均差异均无统计学意义(P>0.05)。r-FSH+HMG+r-LH组Gn总费用显著高于r-FSH+HMG组(P<0.05)。在Gn启动日时,r-FSH+HMG+r-LH组的血清LH水平显著降低(P<0.05)。在HCG扳机日时,r-FSH+HMG+r-LH组的血清LH水平显著降低,卵泡数显著增多(P<0.05)。r-FSH+HMG+r-LH组的MII卵数、MⅡ卵率显著高于r-FSH+HMG组(P<0.05),其获卵数、受精率、卵裂率、优质胚胎率、囊胚形成率具有升高的趋势(P>0.05)。r-FSH+HMG+r-LH组的胚胎着床率显著升高(P<0.05),其β-HCG阳性率、临床妊娠率、持续妊娠率具有升高趋势(P>0.05)。结论针对早卵泡期长效长方案的患者联合使用r-FSH+HMG+r-LH进行促排卵,不仅可提高卵母细胞成熟率,促进胚胎着床,还可减轻患者的经济负担。

Objective There is no consensus on the addition of exogenous recombinant luteinizing hormone(LH)during the long acting regimen of ovulation induction in the early follicular stage.This paper aims to investigate the effect of LH on IVF/ICSI assisted pregnancy outcome in the long-acting regimen of early follicular stage.Methods From July 2018 to December 2021,a total of 508 patients who received long-acting and long-acting ovulation promotion in the early follicle stage in the Department of Reproductive Medicine,Eastern Theater General Hospital were retrospectively analyzed.According to the gonadotropin(Gn)regimen,the patients were divided into rFSH+HMG group[patients added recombinant human follicular stimulating hormone(rFSH)and human menopausal gonadotropin(HMG)]and rFSH+HMG+rLH group[patients used rFSH,HMG and recombinant luteinizing hormone(rLH)during ovulation induction].The clinical characteristics and assisted pregnancy outcomes of the two groups were compared.Results There were no significant differences in age,BMI,infertility years,basic sex hormone levels(FSH,LH,PRL,E2,T,P),anti-Muller's tube hormone(AMH)and sinus follicle number(AFC)between 2 groups(P>0.05).There were no significant differences in total Gn,days of Gn use,rFSH and HMG dosages between 2 groups(P>0.05).The total cost of Gn in rFSH+HMG+rLH group was significantly higher than that in rFSH+HMG group(P<0.05).Serum LH level in rFSH+HMG+rLH group was significantly decreased on Gn initiation day(P<0.05).On HCG trigger day,serum LH level in rFSH+HMG+rLH group was significantly decreased,and follicle number was significantly increased(P<0.05).The number of MII eggs and the rate of MⅡeggs in rFSH+HMG+rLH group were significantly higher than those in rFSH+HMG group(P<0.05),and the number of eggs obtained,fertilization rate,cleavage rate,high-quality embryo rate and blastocyst formation rate had an increasing trend(P>0.05).The implantation rate of rFSH+HMG+rLH group was significantly increased(P<0.05),and the positive rate ofβ-HCG,clinical pregnancy rate and sustained pregnancy rate had an increasing trend(P>0.05).Conclusion The combination of rFSH+HMG+rLH for ovulation induction in patients with long-acting regimen at early follicular stage can not only improve the rate of oocyte maturation,promote embryo implantation,but also reduce the financial burden of patients.